The Intersection of Public Housing, Homelessness and Mental Health


Mental health issues are a global epidemic.  Successfully addressing these mental health problems is not something that can happen in isolation.  The mantra “Housing is healthcare” is a mindset that has been adopted across many providers, including housing organizations, that serve individuals experiencing homelessness and those living with mental illness   Housing for homeless and those facing mental health has long been divided out from the public housing sector.  Of course, Public Housing Authorities (PHA) provide housing for many who were homeless and or mentally ill, but historically a PHA is not the place a homeless person typically turns to.

In the USA, most PHAs have extremely long waitlists.  If a homeless person living with a mental illness comes in to ask for housing, they would probably be told the waitlist is closed or that it is 5 years of waiting.   In addition, check ins and not updating waitlist statuses is usually a reason for getting dropped off the list.  PHAs are also not equipped to help those with serious mental health issues.  When there are outbursts, issues, conflicts and even drug use, a PHA is a landlord and must act in the best interest of all the residents in the building as well as the asset they are preserving.   Historically this has made it extremely hard for PHAs to be a good landing space for homeless and or those with mental health issues.

Housing without Services is Doomed to Fail:

Many PHAs have preferences for who they house.  Sometimes it is for elderly or disabled and quite often it is for those experiencing homelessness.   In many instances, those experiencing homelessness are also suffering from mental health issues.  When these people come to the top of the waitlist and are housed, it can lead to the termination of one problem and open a world of other issues.  If a PHA does not have specialized staff on hand or partnerships in place, the results of housing mentally ill homeless could be bad for both parties.  I have personally visited over a dozen PHAs in the USA and saw many folks sleeping on cardboard boxes in their apartments.  They had no resources after lease up and ended up in a very scary and uncomfortable place.  The networks on the street disappear and are replaced with a building full of strangers.  The rules and regulations of living in public housing are often hard for these people to deal with.  Some of the issues include:

  • Passing HQS or UPCS inspections
  • Issues around pests like bedbugs and roaches
  • Paperwork problems like annual review paperwork that they do not understand
  • Issues getting along with neighbors
  • Outbursts, conflicts, episodes

When any of these types of problems arise, a PHA without resources will respond with a 10-day notice.  After 3 of these are served, the formerly homeless will become homeless once again.  What issue has been resolved if this is the case?  A policy without foresight has caused a person to go through an eviction that will make the chances of them getting housing again even tougher.

Mercy Maricopa, Maricopa and Tempe Housing: A Model for Public Housing Authorities-

If a PHA wants to be housing homeless and those with mental health issues, it is time to get in the game of having the right resources available.  Every PHA should be involved in with the most suitable mental health institutions within their cities and regions.   Key staff on the executive board should be heavily engaged in that community to make sure all partnerships are being leveraged.  In addition, PHAs should consider hiring mental health professionals on staff.  There will never be enough money to go around but looking holistically at the agency might make it clearer where resources should be allocated. If your agency wants to house homeless, get smart and be ready to follow through.

Perhaps one of the best examples in the USA is a partnership called the Bridge to Permanency Program between Mercy Maricopa and two housing authorities in Arizona.  The Bridge program allows the mental health professionals to  work with the housing professionals and find the best possible solutions for their respective clients.   Mercy Maricopa, the Regional Behavioral Health Authority in Maricopa County, contracts with Permanent Supportive Housing service providers to provide the necessary supportive services that work with these homeless individuals that are living with a serious mental illness to find and sustain housing.  The PHA’s provide the housing expertise as well as the necessary systems like rent calculations and HQS inspections.

Mercy Maricopa’s Permanent Supportive Housing Services may include assistance with daily activities, skills training and development, transportation, health education, conflict resolution, crisis response, and assistance with socialization and seeking employment.

The two organizations work together and help the the resident/client get to a space where they can transition from a short term subsidy to a long term permanent subsidy.  It is the services that make this possible.  The resident/client receives help from the start and continuing support.  This is a model every PHA in the USA should look to mimic.  You can find more for Maricopa County Housing in their annual plan here.


I believe that Housing Authorities would  be better to change local policy and get rid of a preference for housing homeless if the proper supports cannot be provided.   This might seem outrageous but homeless persons with mental health issues cannot simply be put into an apartment without help and expect to do well.   Housing homeless and those with mental health is a serious job.  In trying to do the noble thing, a public housing authority could be setting up a person for a greater fall.  If your organization does not have the resources to successfully house homeless persons with mental health problems, why would you create those preferences and be surprised when things don’t go well.

Housing Futures is interested in what other housing organizations are doing around the world in the realm of homelessness and mental health. Have you seen other good examples?  Please email us at


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